Get Out of My Emergency Room!

San Diego  On June 19 at 220 Broadway, just outside room 30, the courtroom of Judge Timothy Walsh, an unlikely group gathered in the narrow hallway to "represent," as it were, at the sentencing of Alissa Valencia. Valencia, 42, had attacked David "the Water Man" Ross on the street, carving much of his defensive right arm into useless meat, requiring emergency surgery.

The unlikely group consisted of some 30 or so of the city's displaced and disenfranchised, people residing in shelters or lodging "illegally" on the streets, where Ross's rounds provide the only source of water in a multiacre area of urban desert known as skid row. The men and women, some in wheelchairs or shuffling with colostomy bags, were dressed in clean shirts, and many had shaved, washed, and combed their hair, likely at the Neil Good Day Center. Beneath the toothpaste and aftershave and deodorant, one could sense morning-maintenance doses of alcohol quickly dissipating in the heat amid courtroom delays. This group was at the hearing, which was that afternoon postponed, to "represent" outrage at the injury of this street Samaritan. They were outraged as well at something almost every one of them had suffered at one time or another during their tenure on the streets and suffered at the hands of those in the very business of care and mercy: the attempted dumping of Ross by Scripps Mercy Hospital in the early hours of May 5, 2007.

Ross was found at the scene of his stabbing, near 17th and Imperial, covered with his own blood and clutching a penknife. Ross had picked up the weapon while in shock, some inner sentinel of reason telling him it might do yet more damage in the wrong hands. Almost anyone's hands at the scene were the wrong hands.

So that is how Ross was found: a white man in his early 70s with a crude tourniquet applied by those who knew him on the streets, rapidly losing blood, and clutching a knife. His ID and wallet locked in his car, Ross looked much like any other deranged derelict who had snapped. That was exactly how he was received and treated at Scripps Mercy. His treatment (reported here on May 24, "Water Man: Down, Then Out") was hardly unique.

In response to that May 24 account, several other victims of hospital mistreatment called, e-mailed, or approached me, either personally or through David Ross.

Ross's attorney in the matter of his treatment at Mercy is Nancy Sussman. The amount of time it took Mercy to surrender Ross's medical records to her was in violation of the evidence code, says Sussman. "Ross was pronounced fit by surgeon Randal Vecchione to go home that night or early the next morning after four hours of surgery, without rechecking the patient. You never do that," she says. Barely conscious, Ross was urged to get up and leave by hospital staff, although he had fallen in the bathroom, unable to stand. At no time was Ross visited by a doctor postsurgery, much less asked how he might be feeling. Nor did any other hospital employee inquire as to his state at any point during his brief stay. He was offered a token for the trolley, which runs nowhere near the hospital, and a pair of pants (his were bloody, ruined, and held by the police).

An Associated Press story that ran in the Union-Tribune on February 10, 2007, by Michael R. Blood regarding a dumping case in Los Angeles and a recent spot on 60 Minutes on the phenomenon brought the situation into focus recently in San Diego. The story in the U-T reported:

"Even on Skid Row, it was shocking: a paraplegic man in a soiled gown sliding along the sidewalk with his hands, clutching a plastic bag with his belongings between his teeth. Police said the man, who was dragging a broken colostomy bag behind him, was dumped on the sidewalk Thursday in one of the worst parts of the city by the driver of a hospital van. The area is the same location where city officials say hospitals have dumped the homeless before....

"The case comes three months after the city attorney's office filed its first indictment alleging homeless dumping, against Kaiser Permanente Hospital."

The differences in San Diego and at Scripps Mercy might be that the transportation back is less reliable. One of Sussman's previous clients was placed naked, except for a sheet, into a taxicab to return to his apartment after an incomplete and minimal evaluation in the emergency room. Several hours after his neighbors carried him upstairs, he suffered cardiac arrest. Ross was simply expected to leave Mercy without so much as a wheelchair to the door -- and he did the next evening with the aid of Suzanne Afflalo, his doctor from Kaiser.

Sussman tells of a woman she represented who lost her baby. "A black patient on Medi-Cal who had excessive bleeding at 25 weeks of pregnancy, she was given a minimal evaluation at Sharp Hospital and discharged, only to lose her baby a few hours later in the bathtub."

In a second incident involving a pregnancy in December 2002, "I took my housekeeper into Scripps Mercy to have her baby, but she didn't have insurance, just Medi-Cal (you don't really call that insurance, right?), and they wouldn't give her an epidural," Sussman says. "I mean, she's screaming in pain, and we couldn't get them to give her an epidural. You have to call the anesthesiologist in, you have to inject it in the spine, you have to go to all this trouble for someone who doesn't have insurance, and you only get, like, ten cents on the dollar. We were literally begging them for an anesthetic, and they wouldn't do it, so she ended up giving birth without it. The baby now is four years old. It was literally ripped out of her. The doctor didn't even show up for the birth."

A Dean Russo-Metavia wrote to me from Carlsbad on May 30 saying, "I was prematurely discharged from a hospital (Scripps Green) before my medical condition was stabilized. My Medicare insurance (Secure Horizons) entitled me to visiting 'Home Nursing care,' it was denied, in spite of my repeated requests.